Creatine is normally found in meat and fish. Creatine is also naturally made in the human body in the kidney and liver. Creatine is mainly stored in muscles, but about 1.5-2% of the body's creatine is converted to creatinine daily.

Creatine supplementation became popular in the 1990s for enhancing athletic performance and building lean body mass. It has also been used in the treatment of chronic heart failure and mitochondrial disorders.

Overall, creatine appears to have modest benefits for intense, repetitive exercise lasting less than 30 seconds. It does not appear to have significant benefits on endurance aerobic exercise.

Caffeine may counteract the benefit of creatine on intermittent exercise performance. Furthermore, creatine in combination with caffeine and ephedra may have adverse effects. However, more research is needed in this area to confirm these interactions.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Several high-quality studies have shown an increase in muscle mass with creatine use. However, some weaker studies have reported mixed results. Overall, the available evidence suggests that creatine does increase lean body mass, strength, and total work. Future studies should include the effect of individual differences such as fitness levels, sex, and age.

A

Research supports the use of creatine supplementation in people with chronic heart failure. Several studies have reported a positive outcome of improved muscle strength and endurance.

B

Some research supports creatine supplementation with cardioplegic solution in patients undergoing coronary artery surgery. Benefits include reduced irregular heartbeat and reduced need for defibrillation. Additional research is needed on this topic.

C

Limited research suggests that long-term creatine use when started early in diagnosis may improve neurologic abilities. Further well-designed studies are needed before conclusions can be made.

C

Early studies of creatine have found mixed results in infants with a breathing disorder called apnea of prematurity. Well-designed studies are needed to better understand this relationship.

C

Aging is associated with lower total creatine and phosphocreatine concentrations. Creatine-induced effects of increased muscle strength, body mass, and performance have not been confirmed in studies on elderly subjects. Additional research is needed in this area.

C

Most studies lack support for creatine in improving performance in trained cyclists. Further research is needed on this topic.

C

Recent studies suggest creatine use in females increases the strength and endurance of muscle contractions. Additional research is needed in this area.

C

Research suggests that creatine may increase endurance in high-intensity exercise. Further research is needed on this topic.

C

Creatine may offer benefit to rowers, for endurance and speed. Additional research is needed in this area.

C

Studies using creatine in runners have mixed results. Overall, most evidence suggests a lack of benefits for runners. However, additional research is needed in this area.

C

Overall, data suggests that creatine may benefit elite hockey players, football players, rowers, squash players, and wrestlers. Improvement was lacking in tennis players. Additional research is needed in this area.

C

Evidence is mixed regarding creatine use during short bursts of anaerobic muscle activity with short recovery times. Additional research is needed in this area.

C

Data on effectiveness of creatine for swimming performance shows mixed results. Additional research is needed in this area.

C

Early research suggests that creatine may benefit bone density effects combined with resistance training. More studies examining creatine alone are needed.

C

Research shows mixed results for creatine use in various cardiac (heart) measurements. Additional research is needed in this area.

C

Limited research reports that creatine supplementation increased muscle mass and exercise performance. Additional research is needed on this topic.

C

Studies evaluating creatine use on cognitive function have reported a lack of benefit. Further well-designed trials are needed in this area.

C

The effect of creatine on dehydration shows mixed results. Additional research is needed in this area.

C

Early research suggests a potential benefit of creatine supplements in depression. Additional research is required in this field.

Limited research suggests that creatine lacks an effect on homocysteine levels in hemodialysis patients. Creatine may offer some benefit for muscle cramping as a complication of hemodialysis. However, further studies are required on this topic.

C

Limited research reports significant effects on severe fibromyalgia when creatine is combined with current medical treatments. Further well-designed studies are needed before conclusions may be made.

C

Guanidinoacetate methyltransferase (GAMT) deficiency is diagnosed by a deficiency of creatine in the brain and has been treated with oral creatine supplementation. Early research suggests that creatine is a potentially effective treatment for disorders of creatine production. Further well-designed trials are required.

C

Preliminary evidence suggests that phosphocreatine use may offer benefits for heart attack when combined with nifedipine. Additional research is required in this area.

C

Limited research suggests creatine may lower cholesterol. Additional, larger studies are needed to in this area.

C

Creatine supplementation has mixed results with regards to Huntingdon's disease. Further well-designed studies are required.

C

High amounts of ornithine may lead to blindness, muscle weakness, and reduced storage of creatine in muscles and the brain. Early evidence suggests that long-term creatine supplements may help replace missing creatine and slow vision loss.

C

Creatine may have significant effects in insulin release and glucose tolerance. Effects on diabetic patients are unclear. Further well-designed trials are required before conclusions can be made.

C

Early evidence suggests creatine has a potential benefit in the total number of premature ventricular beats. More research is needed in this area.

C

Creatine may be beneficial for the treatment of McArdle's disease. However, larger trials are necessary before a conclusion can be made.

C

Studies suggest that creatine supplementation increases speed of brain processing in vegetarians and the elderly. Further information is required on this topic.

C

Preliminary results suggest that creatine supplementation does not improve work production in individuals with multiple sclerosis. Additional well-designed studies are required before a conclusion can be made.

C

According to preliminary research, creatine helped maintain or increase lean body and tissue mass, strength, and endurance in HIV-related and cast-induced muscle wasting. More well-designed clinical trials are needed before conclusions can be made.

C

The decrease of intracellular creatine in Duchenne muscular dystrophy may aggravate muscle weakness and deterioration. Some studies showed preliminary evidence supporting the use of creatine to alleviate these symptoms of muscular dystrophy. More clinical trials are required in this area.

C

The evidence for the use of creatine for individuals with neuromuscular diseases is unclear. It is possible that creatine may be useful in some, but not all, mitochondrial diseases. Future studies are needed in this area

C

One study reported significant effects of creatine with glycerol on orthostatic hypotension. The effects of creatine alone are unclear. Further well-designed clinical trials are required before conclusions can be made.

C

Limited research suggests that creatine may improve physical function, lower limb mass, and quality of life in postmenopausal women with osteoarthritis. The effect of creatine alone, without exercise, is unclear.

C

In limited research, creatine was reported to slow progression of Parkinson's disease and slightly decrease the use of symptomatic treatment. Further well-designed clinical trials are required on this topic.

C

Early research suggests that creatine may be beneficial for Rett syndrome. Additional well-designed trials are required before conclusions can be made.

C

Creatine skin products, in combination with other supplementation, may benefit skin aging conditions such as wrinkles, crow's feet, and (ultraviolet) UV damage. Further well-designed trials are needed before conclusions can be made.

C

Limited research reports inconclusive results on creatine supplementation for spinal cord injury. Further studies are required in this field.

C

Preliminary evidence suggests creatine may reduce hospital stay and intubation duration in people with traumatic brain injury. Further well-designed clinical trials are needed on this topic.

C

Overall, evidence suggests that creatine supplementation does not benefit individuals with amyotrophic lateral sclerosis (ALS). Additional research is needed in this area.

D

Data on the effectiveness of creatine in exercise is mixed. For increased endurance during aerobic exercise, the majority of studies failed to demonstrate benefit. Additional research in this area is warranted.

D

Preliminary research on creatine supplementation reported a lack of benefit in quality of life, cholesterol, and triglyceride levels in people with coronary artery disease (heart disease). Further well-designed clinical trials are needed before conclusions can be made.

D

Early research on the effects of creatine on Angelman syndrome, a genetic neurological disorder found that a combination supplement containing creatine was ineffective in reducing symptoms. Additional research on this topic is needed.

D

Early research on the effects of creatine on spinal muscular atrophy reported a lack of significant effects. Further well-designed trials are needed before conclusions can be made.

D

In preliminary research, creatine supplementation in individuals undergoing soft tissue surgery lacked effects on strength or body composition. Additional research is needed in this area.

D

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

For aging, 0.3 grams/kilogram of creatine has been taken by mouth for five days, followed by 0.07grams/kilogram by mouth for 79 days.

For amyotrophic lateral sclerosis (ALS), 3-30 grams of creatine has been taken by mouth daily for seven days to 56 weeks, in one or two divided doses.

For bone density, 0.3 grams/kilogram of creatine has been taken daily by mouth for five days, followed by 0.07 grams/kilogram daily by mouth for 79 days.

For chronic obstructive pulmonary disorder (COPD), 17.1-22 grams of creatine has been taken daily by mouth for five days to two weeks, followed by 3.76-5.7 grams daily for seven to 12 weeks. A dosage of 0.3 grams/kilogram of creatine has been taken daily by mouth for seven days, followed by 0.07 grams/kilogram daily for seven weeks.

For cognitive function, 0.03 grams/kilogram of creatine has been taken daily by mouth for six weeks. In people with blocked coronary arteries, 2 grams of creatine phosphate has been injected into the blood over a two-hour time period, followed by 8 grams of creatine phosphate injected into the blood on the day of admission. Individuals also received 2 grams of creatine phosphate injected into the blood twice daily at the rate of 4 milliliters/minute for two additional days after admission. The total dose of creatine phosphate was 18 grams over three days.

For congestive heart failure, 20 grams of creatine has been taken by mouth daily for five days. Doses of 5-6 grams have been injected into the blood for up to five days. Additionally, 2 grams has been injected into the blood daily for two weeks, followed by 0.5 grams injected into the muscle daily for one month. One gram injected into the blood daily for seven days has also been used.

For coronary heart disease (surgery), 4 grams of creatine has been injected into the blood daily for three days with cardioplegic solution. Additionally, 10 millimoles/liter of creatine with cardioplegic solution has been given.

For dehydration, 0.3 grams/kilogram of creatine has been taken by mouth daily or 10-25 grams has been taken in 1-2 divided doses daily for 5-28 days.

For depression, 3-5 grams of creatine has been taken by mouth daily for four weeks.

For diabetes (type 2), 3 grams of creatine has been taken by mouth once or twice daily for five days.

For dialysis, 2 grams of creatine has been taken by mouth daily for two treatment periods of four weeks, separated by a washout of four weeks. A dose of 12 milligrams of creatine has been taken by mouth before each dialysis session for four weeks. Additionally, 12 milligrams of creatine before each dialysis session has been injected into the blood for four weeks.

For enhanced athletic performance (loading dose), the typical dosing is four times daily for loading and twice daily for maintenance. Water intake should be 64 ounces daily to avoid dehydration. To rapidly increase muscle creatine levels and increase muscle mass or strength, 9-25 grams or 0.25-0.3 gram/kilogram of creatine has been taken by mouth daily for 4-7 days.

For enhanced athletic performance (maintenance dose), 2-20 grams of creatine has been taken by mouth daily for five days to 12 weeks. A dose of 0.03-0.15 gram/kilogram of creatine has been taken by mouth daily for up to seven weeks, twice or thrice weekly, as has 10 grams of creatine daily for three weeks following a loading dose.

For enhanced athletic performance (aging), 5-20 grams or 0.25-0.5 gram/kilogram of creatine has been taken by mouth daily for five days to 14 weeks or three days weekly for 12 weeks. 0.3 gram/kilogram or 20 grams of creatine has been taken by mouth daily for 5-10 days, followed by 0.07 gram/kilogram or 4 grams by mouth daily for approximately 20 days to 11 weeks.

For enhanced athletic performance (cyclists), 25 grams of creatine by mouth daily for five days plus 5 grams per hour during testing has been used. A dosage of 5-20 grams of creatine by mouth daily for 5-7 days has been used

For enhanced athletic performance (endurance; general), 6-25 grams of a creatine loading dose has been taken daily for 5-7 days or for five days before exercise. 20 grams of creatine has been taken daily for seven days, followed by 2 grams daily for maintenance.

For enhanced athletic performance (high-intensity endurance), 0.25-0.3 grams/kilogram, 2.25 grams, 10 grams, 20 grams, or 25 grams of creatine has been taken by mouth daily for 5 days to six weeks.

For enhanced athletic performance (rowers), 20 grams or 240-300 milligrams/kilogram of creatine has been taken by mouth daily for five days.

For enhanced athletic performance (runners), 0.35 grams/kilogram or 20-25 grams of creatine has been taken by mouth daily for 3-7 days.

For enhanced athletic performance (sports/general), 15-30 grams of creatine has been taken by mouth daily for five days to four weeks, as has 20 grams daily for five days followed by 5 grams daily for 10 weeks. A dose of 0.3 grams/kilogram of creatine has been taken by mouth daily for six days as a loading dose followed by 0.03 grams/kilogram daily for four weeks. Additionally, 20 grams of creatine has been taken by mouth daily on days 1-4, followed by 10 grams daily on days 5-6, and 5 grams daily on days 7-28.

For enhanced athletic performance (sprinters), 300 milligrams/kilogram or 10-35 grams of creatine has been taken daily for 2-7 days. Additionally, 15-20 grams of creatine has been taken daily for 5-7 days, followed by 2-10 grams daily for 9-21 days.

For enhanced athletic performance (power and spring performance), loading doses of 6-35 grams or 0.3 grams/kilogram of creatine have been taken daily for up to seven days, with maintenance doses of up to 10 grams or 0.03 grams/kilogram daily for up to seven weeks.

For enhanced athletic performance (swimming), 10-25 grams of creatine has been taken by mouth daily in single or divided doses for four to nine days. 0.3 grams/kilogram of creatine has been taken by mouth daily for five days followed by 2.25 grams daily. 20 grams of creatine has been taken by mouth daily for six days, followed by 10 grams daily for eight days.

For GAMT deficiency (lack of an enzyme for creatine production), 400-670 milligrams/kilogram has been taken daily by mouth. 4-8 grams of creatine has been taken daily by mouth for 25 months.

For heart health, 5 grams of creatine has been taken twice daily by mouth for three weeks. A dose of 7 grams of creatine has been taken three times daily by mouth for three days, then 21 grams once daily on the fourth day.

For heart attack, 2 grams of creatine has been injected into the blood, followed by 4 grams per hour injected into the blood for two hours. A dose of 4 grams has been injected into the blood, followed by 8 grams injected into the blood over two hours, and 8 grams per 24 hours injected into the blood for five days. Additionally, 18 grams of Neoton® has been injected into the blood for the first three days of a heart attack.

For Huntington's disease, 5-10 grams of creatine has been taken by mouth daily for up to one year.

For high cholesterol, 20-25 grams of creatine has been taken by mouth daily for five days, followed by 5-10 grams daily for 51 days.

For hyperornithinemia (high ornithine levels), 1.5 grams of creatine has been taken by mouth daily for one year.

For insulin potentiation, 5 grams of creatine has been taken by a tube into the stomach at three equally spaced intervals in one day. Additionally, 10 grams has been taken daily by mouth for greater than three months.

For ischemic heart disease, 400 milligrams of creatine has been injected into the muscle daily and 200 milligrams has been injected into the blood daily for 10 days.

For McArdle's disease (metabolism disorder), 150 milligrams/kilogram of creatine has been taken by mouth daily for five days, followed by 60 milligrams/kilogram daily for five weeks.

For memory, 5 grams of creatine taken by mouth once or four times daily has been taken from one to six weeks.

For muscle strength, 1 gram of creatine phosphate has been injected into the blood daily for 30 days.

For muscle wasting, 20 grams of creatine has been taken by mouth daily for five days, followed by a maintenance dose of 4.8 grams daily, for a total of 14 weeks. Additionally, 5 grams of creatine has been taken four times daily for seven days.

For muscular dystrophy, 10 grams of CreapureTM has been taken by mouth daily for eight weeks, 3 grams daily for three months, or 0.1 grams/kilogram daily for four months. A dosage of 3-20 grams of creatine daily or 0.06-0.15 grams/kilogram of creatine daily has been taken by mouth for one week to six months. 20 grams of creatine has been taken daily for one week, followed by 5 grams daily for an additional eight weeks.

For neuromuscular disorders, 10 grams of creatine has been taken by mouth daily for five to 14 days, followed by 4-5 grams daily for five to seven days. A dosage of 4-20 grams of creatine has been taken by mouth daily in 1-4 divided doses for five days to 4 weeks, as has 150 milligrams/kilogram daily for six weeks.

For orthostatic hypotension (low blood pressure upon standing), 20 grams of creatine has been taken by mouth daily for six days.

For osteoarthritis, 20 grams of creatine has been taken by mouth daily for one week, followed by 5 grams daily thereafter for 12 weeks.

For Parkinson's disease, 10 grams of creatine has been taken by mouth daily for 12 months.

For Rett syndrome (neurodevelopmental disorder), 200 milligrams/kilogram of creatine has been taken by mouth daily for six months.

For spinal cord injury, 10 grams of creatine has been taken by mouth twice daily for six days, then maintained with 5 grams daily. Additionally, 20 grams of creatine has been taken by mouth daily for seven days, followed by a 21-day washout period, then repeated for another seven days.

For surgical recovery (soft tissue), 10 grams of creatine has been taken daily by mouth for 10 days before surgery and 5 grams daily by mouth for 30 days after surgery.

Children (younger than 18 years)

For AGAT deficiency (lack of enzyme for creatine production), a child aged received up to 800 milligrams/kilogram of creatine by mouth daily and was followed for eight years.

For apnea (cessation of breathing), 200 milligrams/kilogram of creatine has been given by mouth daily for two weeks.

For GAMT deficiency (lack of an enzyme that produces creatine), the following doses have been given, 2 grams/kilogram of body weight by mouth, 4-8 grams by mouth daily in an infant for 25 months, and 400-670 milligrams/kilogram of body weight by mouth for up to two years. Dosing in children should be done under medical supervision because of potential adverse effects.

For muscular dystrophy, 5 grams of CreapureTM has been given by mouth daily for eight weeks.

For neuromuscular disorders, a dose of 0.1 gram/kilogram of creatine daily by mouth for one week has been used.

For Rett syndrome (neurodevelopmental disorder), children three years and older received 200 milligrams/kilogram of creatine by mouth daily for six months.

For spinal muscular atrophy, children aged 2-5 years were given 2 grams of creatine daily by mouth, and those aged 5-18 years were given 5 grams daily by mouth for six months.

For traumatic brain injury, 0.4 grams/kilogram of creatine oral suspension was taken by mouth daily for six months.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid with known allergy or sensitivity to creatine.

Although creatine is a common dietary component (in meat and fish), allergy to creatine has been reported. Mild asthma-like symptoms after chronic consumption of creatine (20 grams daily for five days followed by 10 grams daily for 51 days) has occurred.

Side Effects and Warnings

Creatine is likely safe when used long-term.

Creatine may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Creatine may cause high blood pressure. Caution is advised in people taking drugs or herbs and supplements that raise blood pressure.

The U.S. Food and Drug Administration (FDA) has advised consumers to consult their physicians before using creatine. There is concern that athletes may exceed recommended doses; under these conditions the side effects are unclear.

Note: There is limited systematic research on the safety, pharmacology, or toxicology of creatine. Individuals using creatine, including athletes, should be monitored by a qualified healthcare professional. Heat intolerance, fever, dehydration, reduced blood volume, or electrolyte imbalances (and resulting seizures) may occur.

Pregnancy and Breastfeeding

There is a lack of sufficient data on the use of creatine during pregnancy or lactation.

In theory, creatine supplementation of nursing mothers may help to avoid creatine deficiency syndromes, but studies focusing on this are lacking. Creatine supplementation is suggested to be avoided unless it is prescribed by a healthcare professional.

Creatine may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.